Inmunoterapia en el cáncer de cervix

Immune-Based Treatment Shows Promise against Metastatic Cervical Cancer

April 16, 2015 by NCI Staff

Dr. Christian Hinrichs and Susan Scott
Dr. Christian Hinrichs and Susan Scott, who participated in the NCI immunotherapy trial, at a follow-up visit. Ms. Scott had a complete response to the treatment that is still ongoing after 24 months. (Photo courtesy of Susan Scott)

Two patients with metastatic cervical cancer had a complete disappearance of their tumors after receiving treatment with a form of immunotherapy called adoptive cell transfer (ACT). A third patient experienced a reduction in tumor size for a short time following the treatment.

The findings, from an early-phase clinical trial conducted by researchers from NCI’s Center for Cancer Research (CCR), were published March 30 in the Journal of Clinical Oncology (JCO).

The treatment tested in the trial consisted of an infusion of immune cells—know as tumor-infiltrating lymphocytes (TILs)—that were collected from each patient’s own tumor and expanded in the laboratory. ACT has had success in small clinical trials of patients with melanoma and some blood cancers conducted by researchers at NCI and several other institutions.

But this is the first time ACT has been tested in patients with cervical cancer, explained the study’s lead author, Christian Hinrichs, M.D., of CCR’s Surgery Branch.

Nearly all cervical cancers are caused by persistent infections with certain types of the human papillomavirus (HPV). HPV-infected cells produce specific proteins, or antigens—known as E6 and E7—that can be recognized by T cells, which are immune cells that play a critical role in the body’s response to infectious agents and infected cells. All of the patients in the trial had tumors that express the E6 and E7 proteins.

The researchers selected for expansion those T cells that would have the greatest likelihood of attacking cancer cells. They did this chiefly by identifying those that were most reactive for the E6 and E7 proteins, although other characteristics were also considered. Patients received chemotherapy before infusion of the expanded T cells and regular infusions with IL-2 for up to three days afterward, both of which have been shown to enhance T cells’ ability to eradicate cancer cells.

The findings published in JCO cover the nine patients in the trial with cervical cancer. The trial also includes patients with other HPV-related cancers, including oropharyngeal and anal cancer.

The two complete responses were ongoing 22 and 15 months after treatment, respectively. One partial response lasted for 3 months. The three patients whose tumors responded to treatment had T cells that were reactive to the HPV proteins. They also had reactive T cells in samples of blood collected one month after treatment. There were no apparent side effects related to the cell infusion, the researchers reported, although most patients experienced side effects from the pre-infusion chemotherapy and post-infusion IL-2 treatments.

“There’s been a lot of hope that’s come from seeing the complete, long-lasting tumor responses in cellular therapy for melanoma and B-cell cancers,” Dr. Hinrichs said. “For the first time, we’re seeing that sort of response in an epithelial cancer.”

Despite coming from a trial with such a small number of patients, “these results are impressive and suggest that this highly personalized therapeutic modality warrants further investigation,” wrote Kunle Odunsi, M.D., Ph.D., of the Roswell Park Cancer Institute, and his colleagues in an accompanying editorial in JCO.

Based on these early results, the trial protocol has been amended so that only patients whose TILs are reactive for the E6 and E7 proteins will receive the treatment. “This way we can only treat the patients with the highest likelihood of responding to the treatment,” Dr. Hinrichs said.

Another trial testing a different form of ACT in patients with HPV-related cancers has been opened at NCI, Dr. Hinrichs added. That trial involves genetically engineering T cells collected from patients’ blood (rather than their tumors) to express a receptor that’s specific for the E6 and E7 proteins.

Fuente: National Cancer Institute: Cancer Currents Blog April 16, 2015 by NCI Staff

Lesiones del cuello uterino. Gráfico hallazgos citológicos.

Cervical cell pathology in squamous tissue #Netter #cytopath #pathology

Cervical cell pathology in squamous tissue. By Netter

Fuente: Tweet de @anaidpath2

Infecciones por el VPH

Vacunas contra los virus del papiloma humano

Microscopia electronica de un Virus del Papiloma Humano

  • ¿Qué son los virus del papiloma humano?
  • ¿Cuáles cánceres se relacionan con las infecciones por los virus del papiloma humano?
  • ¿Puede evitarse la infección por VPH?
  • ¿Qué son Gardasil y Cervarix?
  • ¿Cómo funcionan las vacunas contra VPH?
  • ¿Qué tan efectivas son las vacunas contra VPH?
  • ¿Por qué son importantes estas vacunas?
  • ¿Qué tan seguras son las vacunas contra los VPH?
  • ¿Quién deberá vacunarse con estas vacunas?
  • ¿Se deberán administrar las vacunas a personas ya infectadas por VPH?
  • ¿Deberán vacunarse las mujeres que ya tienen cambios en las células cervicales?
  • ¿Necesitan hacerse todavía pruebas de Papanicolaou las mujeres que se hayan vacunado?
  • ¿Cuánto cuestan estas vacunas? ¿Pagará el seguro médico por ellas?
  • ¿Qué investigaciones se están realizando acerca de los VPH?
  • ¿Cómo se puede aprender más acerca de la infección por VPH?

Las respuestas en: National Institute of Cancer

Fuente: Tweet de @theNCI

HPV Screening Alone May Miss Cervical Cancer

Comparison of cervical cancer screening results among 256,648 women in multiple clinical practices.

Blatt, A. J., Kennedy, R., Luff, R. D., Austin, R. M. and Rabin, D. S.

Cancer Cytopathology. 2015. doi: 10.1002/cncy.21544

Abstract. BACKGROUND. In the United States, human papillomavirus (HPV) and Papanicolaou (Pap) testing (cotesting) for cervical screening in women ages 30 to 65 years is the preferred strategy, and cytology alone is acceptable. Recently, a proprietary automated test for identifying high-risk HPV types for primary cervical screening was approved by the US Food and Drug Administration. The objective of the current study was to document extensive cervical screening among these screening options. METHODS. To investigate the sensitivity of various testing options for biopsy-proven cervical intraepithelial neoplasia grade 3 or worse (≥CIN3) and cancer, the authors reviewed 256,648 deidentified results from women ages 30 to 65 years at the time of cotest who had a cervical biopsy specimen obtained within 1 year of the cotest. RESULTS. A positive cotest result was more sensitive (98.8%; 4040 of 4090 cotests) for diagnosing ≥CIN3 than either a positive HPV-only test (94%; 3845 of 4090 HPV-only tests) or a positive Pap-only test (91.3%; 3734 of 4090 Pap-only tests; P < .0001). A positive Pap-only result was more specific (26.3%; 66,145 of 251,715 Pap-only tests) for diagnosing ≥CIN3 than a positive HPV-only test (25.6%; 64,625 of 252,556 HPV-only tests) or a positive cotest (10.9%; 27,578 of 252,558 cotests; P < .0001). Of 526 cervical cancers, 98 (18.6%) were HPV-only negative, 64 (12.2%) were Pap-only negative, and 29 (5.5%) were cotest negative. CONCLUSIONS. Compared with HPV-only testing, cotesting was more sensitive for the detection of ≥CIN3 in women ages 30 to 65 years. The current data suggest that approximately 19% of women with cervical cancer may be misdiagnosed by an HPV-only cervical screen. It is important to consider these data as the guidelines for cervical cancer screening undergo revision. Cancer (Cancer Cytopathol) 2015. © 2015 The Authors. Cancer Cytopathology published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Measure Cotesting Pap Only HPV Only
Sensitivity, % 98.80 91.30 94.00
Specificity, % 10.90 26.30 25.60
Positive predictive value, % 1.76 1.97 2.00
Negative predictive value, % 99.83 99.50 99.62


This study was conducted by Quest Diagnostics Health Trends. Dr Austin has disclosed no relevant financial relationships. Some of his coauthors are employees of Quest Diagnostics.

Cancer Cytopathol. Published online April 10, 2015. Abstract

Fuente: Medscape


DermNet NZ

DermNet New Zealand Trust

DermNet NZ provides authoritative information about skin diseases, conditions and treatment for patients and their health professionals. Information provided on DermNet NZ should not be regarded as medical advice for individuals.

Magnífica página sobre la Dermatopatología desde Nueva Zenlanda.

Obama "patólogo"

President Barack Obama looks through a microscope during his tour the Bio-technology program at Forsyth Tech Community College in Winston-Salem, N.C., Monday, Dec. 6, 2010.
President Barack Obama looks through a microscope during his tour the Bio-technology program at Forsyth Tech Community College in Winston-Salem, N.C., Monday, Dec. 6, 2010.

Fuente: Tweet de @Haneen_Maghrabi

Whole Slide Viewer Zoom

microDimensions Zoom

microDimensions Zoom is a free of charge digital pathology viewer for fast visualization of whole slide images. It supports an unlimited number of channels and all major proprietary as well as generic file formats. It is a lightweight piece of software to easily and quickly view, share, and discuss cases.

Zoom — Free Digital Pathology Viewer

Fuente: TissuePathology - 2015/04/16

BRAC Video informativo en inglés de CDC

HPV y cáncer

HPV and Cancer

Virus del papiloma humano y el cáncer National Cancer Institute (en español)

Fuente: Tweet de @theNCI.

Gardasil 9 Vaccine Protects against Additional HPV Types


In a large randomized clinical trial, a new human papillomavirus (HPV) vaccine effectively prevented infection and disease caused by nine high-risk HPV types, including seven types that cause cervical and other cancers—five of which were not covered by the previously available HPV vaccines—and two types that cause genital warts.


New England Journal of Medicine, February 18, 2015 (See the abstract.)

Fuente: National Cancer Intitute
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WHO/OMS ICD-10 Version: 2015

International Classification of Diseases (ICD)

The International Classification of Diseases (ICD) is the standard diagnostic tool for epidemiology, health management and clinical purposes. This includes the analysis of the general health situation of population groups. It is used to monitor the incidence and prevalence of diseases and other health problems, proving a picture of the general health situation of countries and populations.

ICD is used by physicians, nurses, other providers, researchers, health information managers and coders, health information technology workers, policy-makers, insurers and patient organizations to classify diseases and other health problems recorded on many types of health and vital records, including death certificates and health records. In addition to enabling the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes, these records also provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States. Finally, ICD is used for reimbursement and resource allocation decision-making by countries.

All Member States use the ICD which has been translated into 43 languages. Most countries (117) use the system to report mortality data, a primary indicator of health status.

ICD-10 was endorsed by the Forty-third World Health Assembly in May 1990 and came into use in WHO Member States as from 1994. ICD is currently under revision, through an ongoing Revision Process, and the release date for ICD-11 is 2017.

Fuente: IC-10 Version 2015

Mortality Trends

Trends in national mortality rates

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Countries: Full sets of graphs are available for 40 countries, including the United Kingdom, the United States, Canada, Sweden, Australia, New Zealand, the Netherlands, Germany, Japan, France, Spain, Singapore and Italy.

Mortality rates: Most mortality rates were calculated using data from the World Health Organization (WHO). WHO is not, however, responsible for any of this site's content.



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Fuente: VisualOnLine.Cancer.Org

Surgical Pathology Criteria

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